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Medicaid forms for providers?
In addition to commercial issuers, the following public issuers must accept the form: Medicaid, the Medicaid managed care program, the Children's Health Insurance Program (CHIP), and plans covering employees of the state of Texas, most Team Care Provider/Pharmacy Change Form 01/2020. The Texas Medicaid & Healthcare Partnership provides the resources to help providers succeed with their Medicaid practice. SoonerPlan Family Planning Waiver. MA300X - Medical Assistance Provider Order Forms for Providers. Apply online or turn your application form into the right office or worker. Requesting direct deposit: Until further notice, please use the MSC 189 (EFT Enrollment Form for Providers, Vendors, and Contractors) to update your EFT account information. KY MPPA requires a provider email address to be associated with the provider KY Medicaid number (existing and new) and is required to secure accounts. Wyoming Medicaid, 4th Floor West Fax: (307) 777-6964. Inquire on a managed care member's eligibility. Find vaccination sites near you and learn more about going a ll-in to get through this together. Preferred Drug Program Website. ndividual or entity; orAn individual or entity has entered into participation in a first offender, deferred adjudication, or other program or arrangement where judgement of conv. EPSDT - A Guide to Keeping Your Kids Healthy/SoonerCare Member Guide - English | Spanish Information. Providers must submit their applications with a valid email address. Helpful documents and links can be found in the menu bar above. Some of the forms used by Arkansas Medicaid and its providers are available in electronic format. Jan 1, 2006 · The following provides access and/or information for many CMS forms. Some of the forms used by Arkansas Medicaid and its providers are available in electronic format. BEIJING, April 28, 2022 /PRNewswire/ -- Zepp Health Corp. As a business owner or service provider, improving your client experience should be a top priority. Chapter E, General Income. John Kasich defended his state's move under Obamacare. English and Spanish forms can be found under the title "Form to apply for Medicaid for the Elderly and People with Disabilities or Medicare Savings Program" under section "Forms to apply for benefits". Chapter B, Applications and Redeterminations. Visit ES H0090-I Notice of Admission, Departure, Readmission or Death of an Applicant/Recipient of Supplemental Security Income and/or Medical Assistance Only in a State Institution H1003 Appointment of an Authorized Representative. Find out what's changing as the public health emergency expires on May 11, 2023 ». Forms. Chapter E, General Income. Mississippi Division of Medicaid. A new form of investment could help foster social change. Division of Managed Care Forms; Medicaid. DMS Medical Assistance Dental Disposition (DMS-2635) Sep 6, 2023 · CMS Forms. Chapter C, Rights and Responsibilities. The goal of MESA is to enhance connections between health services systems and improve access to health information Phone: (202) 645-4500 Taylor Street Service Center, NW. Claims Status and Other Questions. Providers can check the status of claims and inquire about claims payment calculation and other related questions by contacting the Claims Advice Processing unit: In-state: 8007691945 Dental: 8771478. Utah Department of Health Medicaid Provider Enrollment Forms. Arizona Health Care Cost Containment System (AHCCCS) is Arizona's Medicaid agency that offers health care programs to serve Arizona residents. Medicaid is a government program that provides healthcare coverage to individuals and families with low income. Chapter H, Co-Payment. (ORDER FORM) Application for Health Coverage & Help Paying Costs (ORDER FORM) Healthchek & Pregnancy Related Services Information Sheet (ORDER FORM) Long-Term Services and Supports Questionnaire (LTSSQ) - Email Request. The Mississippi Division of Medicaid values all types of health care providers enrolled in the Medicaid program. We hope you don't have to pay out of pocket for the benefits you get as a Humana Healthy Horizons in Florida member. SoonerCare is a collection of Oklahoma health care benefit packages including Traditional (Fee-For-Service Medicaid), Choice (Medical Home), Supplemental (Medicare Crossover), SoonerPlan (Family Planning) and others. My Account Medicaid and the Children's Health Insurance Program (CHIP) provide health coverage for low-income children, families, seniors and people with disabilities. MHCP also excludes individuals and entities from participation in MHCP if they are on either the federal or state excluded provider list. Notes on releasing information about your health. MHCP also excludes individuals and entities from participation in MHCP if they are on either the federal or state excluded provider list. Getting into proper form is essential, and this video provides 3 quick tips for doing it right. English and Spanish forms can be found under the title "Form to apply for Medicaid for the Elderly and People with Disabilities or Medicare Savings Program" under section "Forms to apply for benefits". Hard copy forms may be available from Intermediaries, Carriers, State Agencies, local Social Security Offices or End Stage. OCDD Waiver Guideline Documents and Forms All Medicaid Provider Manuals with Updated Chapters can be found here. Your health department might have a list of medical providers that participate with straight Medicaid. Provider Forms - Related Files Provider Request for Extended Repayment Plan - Posted 12/4/18 (PDF, 134. Beginning on August 1, 2018, the provider may have to call the Office of Medical Assistance Programs' Department of Provider Enrollment at 1-800-537-8862 to request a paper application if the PDF version of the application is no longer posted on the DHS Provider Enrollment website. My Account Medicaid and the Children's Health Insurance Program (CHIP) provide health coverage for low-income children, families, seniors and people with disabilities. Most of the files below are in Adobe PDF. It is designed to help those who cannot afford private health insu. NOTE: Health Management Systems (HMS) is under contract with Alabama Medicaid to process the "Request for Medical Records" and perform the evaluation and case tracking functions of all casualty and litigation cases. Managed Care Provider Complaint Portal. Medicaid provider participation and public process to inform access to care § 447 V Appendix A. W-9 Form (PDF) Provider Resources. The member MUST authorize the change/enrollment. Expand sub pages Credentialing. The federal Health and Human Services Office of Inspector General (OIG) has the authority to exclude individuals and entities from participation in Medicare, Medicaid, and other federal health care programs. Authorization by Clinic/Group Members for Direct Deposit, Address or Payment Change. You must complete each step in the Enrollment application. Chapter G, Eligibility Budgets. Welcome to Indiana Medicaid. Recipients with special ride needs for dialysis, radiation or other treatments should contact the NET program at 1-800-362-1504. Disenroll from the IHCP. Jan 1, 2006 · The following provides access and/or information for many CMS forms. Medicaid Provider Services contact and resource page. 2217 - Provider Appeals and. For more information on using the portal, please visit the Billing 101 Training. As always, your search terms will be highlighted in the results. On this site, you can learn about the different Medicaid programs and how to apply. This page offers quick access to the forms you use most. This is a public health insurance program which provides needed health care services for low-income individuals including families with children, seniors, persons with disabilities, foster care, pregnant women, and low income people with specific diseases such as tuberculosis, breast cancer, or HIV. The Louisiana Department of Health protects and promotes health and ensures access to medical. All MAP (Medicaid Assistance Program) Agreements and forms are available in the Adobe Acrobat format, and require the Adobe Acrobat Reader … Both the Zurich Superannuation Plan (ZSP) and Zurich Account-Based Pension (ZABP) PDS and the Zurich Superannuation Plan Optional Protection Benefits … Welcome to Zurich for advisers. The Indiana Health Coverage Programs (IHCP) provider reference modules are the primary reference for billing and reimbursement guidance for providers conducting business with the IHCP. Others are added as they become available. Medicaid is a government program that provides healthcare coverage to low-income individuals and families. Patients must renew their Medicaid eligibility annually to continue their coverage. Crisis Respite Apartment Checklist. ahss sharepoint login Tell patients to respond to their NJ FamilyCare renewal packet. Your health department might have a list of medical providers that participate with straight Medicaid. Health care professionals can access forms for UnitedHealthcare plans, including commercial, Medicaid, Medicare and Exchange plans in one convenient … This web page serves as a central repository for Wyoming Medicaid Forms. Personal Care Services Coverage Policy [ 159. A Medicaid asset protection trust can be used to shield assets to avoid spend down requirements. Community Based Adult Services (CBAS) Request Form. FAQ-Forms Invoices Handbooks. Crisis Respite Apartment Checklist. Provider Application and Participation. Or call the medical provider. TTY Callers: Dial 7-1-1 for Relay Nevada, then request to be connected to (800) 525-2395 (select option 1, then option 4). Louisiana Medicaid Provider Number - enter your 7-digit Louisiana Medicaid provider number (if known) in the boxes, one digit per box. In addition, the Portal provides access to a wide variety of IHCP information and resources. Home » Healthcare Financing » Wyoming Medicaid » Medicaid Provider Enrollment & Billing. Enrolling online allows providers to complete the enrollment process through self-service screens that can be accessed HERE. Nonemergency medical transportation services are available for a Medicaid beneficiary or their child. One effective way to enhance client satisfaction and streamline your operations. Other Provider Types. Medicaid is a state/federal program that pays for medical services for low-income pregnant women, children, individuals who are elderly or have a disability, parents and women with breast or cervical cancer. A Medicaid health plan for more complex health needs Tailored Plans cover doctor visits, prescription drugs and services for serious mental health, severe substance use, I/DD and TBI all in one plan. Medicare-Medicaid plan forms. Please read the agreement and complete the last page. Texas Medicaid & Healthcare Partnership. jojo the hand Medicaid Provider Appeals may be submitted by U Mail or in-person delivery, by facsimile, or e-mail. Signed by hand or validated electronic signature are required; typed-in signatures are not allowed. Here's how to know if you qualify and what to do if you don't. Find fee schedules provider and program guidance, manuals and forms. (ORDER FORM) Application for Health Coverage & Help Paying Costs (ORDER FORM) Healthchek & Pregnancy Related Services Information Sheet (ORDER FORM) Long-Term Services and Supports Questionnaire (LTSSQ) - Email Request. CSHCN Services Program Texas Health Steps. Here are your health insurance options if you're one of them. Long-Term Nursing Facilities. Ohio Medicaid providers may contact the Interactive Voice Response (IVR) system for billing concerns. If you'd like a printed version of a form or publication, make sure it's available in print first. When you have completed all of the steps, including uploading all required supporting. Affidavit for Meal Providers to the Homeless H1833: Your Medicaid Benefits Are Ending - Cover Letter: ES: H1833-L: Your Medicaid Benefits Are Ending: ES: H1834: Your Medicaid Benefits Have Ended - Cover Letter: ES: H1834-L: Your Medicaid Benefits Have Ended: ES: H1836-A: Medical Release/Physician's Statement: ES: H1836-B: Medical Release. The file downloads found below represent the more popular and important downloads available from the MES portal. lightelligence Access forms and documents for various services provided by the Arkansas Department of Human Services. Health care professionals can access forms for UnitedHealthcare plans, including commercial, Medicaid, Medicare and Exchange plans in one convenient … This web page serves as a central repository for Wyoming Medicaid Forms. The Centers for Medicare & Medicaid Services (CMS) is a Federal agency within the U Department of Health and Human Services. Provider updates and announcements, important reference materials, and general program information are all available through links and webpages located on this website. All requests for PA must be submitted according to DMA clinical coverage policies and published procedures. Jan 1, 2006 · The following provides access and/or information for many CMS forms. Consumer Applications To apply for health and human services see the consumer section of this website. Provider Dispute … When submitting offline business (Paper/PDF completed and emailed to Zurich) it's really important you're using the most up-to-date version of our application forms. Provider Enrollment Ambulance. Notes on releasing information about your health. Chapter A, General Information and MEPD Groups. For more information on determining your category of eligibility and. ® Marks of the Blue Cross and Blue Shield Association. SeniorsMobility provides the best information to seniors on how they can stay active, fit, and healthy. SoonerCare providers who can apply online include: All Medicaid providers must enroll with the program. Some of the forms used by Arkansas Medicaid and its providers are available in electronic format. Jan 1, 2006 · The following provides access and/or information for many CMS forms. IHCP Provider Reference Modules.
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Note: If you are also enrolling in the CSHCN Services Program, you must complete the following forms that are available for download at wwwcom: CSHCN Services Program Identification Form. Instructions. Comments about the forms may be directed to medicaidops@utah Provider resources: Quick guides, known issues, EDI, & training. English and Spanish forms can be found under the title "Form to apply for Medicaid for the Elderly and People with Disabilities or Medicare Savings Program" under section "Forms to apply for benefits". NH Medicaid (Medical Assistance) is a federal and state funded health care program that serves a wide range of individuals and families who meet certain eligibility requirements. ☎ Customer Relations: 866-843-7212. Mississippi Division of Medicaid. Chapter H, Co-Payment. If you’re covered by Medicaid for your health care, you may wonder if you qualify for vision screenings, eyeglasses and other vision-related medical services. Trading Partner Agreement 07/19/13. Form 2606, Managed Care Enrollment Processing Delay ES Form 5831, Community-based Programs Access and Eligibility Services Contract Application Packet Checklist, Regionally Enrolled Form 3854-A, Emergency Response Services Procedures Form 2307, Rights and Responsibilities ES Medicaid Benefit Hearings Forms. Chapter G, Eligibility Budgets. Delaware State Contacts Enrollment. Find the OHP application in multiple languages on the Apply for OHP page. Chapter D, Non-Financial. Providers, partners, and members: Learn how the end of the COVID-19 Public Health Emergency affects members with OHP and other benefits. Jan 1, 2006 · The following provides access and/or information for many CMS forms. NEW! Medicaid Providers: Talk to your patients about important updates to their NJ FamilyCare/Medicaid coverage. You may also use the "Search" feature to more quickly locate information for a specific form number or form title. These forms have been updated to a format that allows them to be completed, downloaded and saved electronically. 75. famous hells angels wives Easily find and download forms, guides, and other related documentation that you need to do business with Anthem all in one convenient location! We are currently in the process of enhancing this forms library. Jul 20, 2023 · Welcome Texas Medicaid Providers. YouTube page for Georgia Medicaid How can we help? Call Us. If you have questions, contact the webmaster or call Medicaid Information at (801) 538-6155 or 1-800-662-9651. How to Contact Your Provider Relations Consultants (PRC) ICD-10 FAQs: ICD-10 News: ICD-10 Provider Sharing: ICD-10 Resources: Idaho Medicaid Information: The Alabama Medicaid Agency's Non-Emergency Transportation program helps eligible recipients pay for rides to dental and doctor offices, hospitals and other medical facilities when the service is also covered by Medicaid. 5010: 5010 Certified: 5010 Companion Guides: Base Document Library: Billing Instructions:. Sunshine Health offers free online accounts for providers. Note: If you are also enrolling in the CSHCN Services Program, you must complete the following forms that are available for download at wwwcom: CSHCN Services Program Identification Form. Instructions. Update Provider Demographics & Other Updates English. In addition, health care providers can use this site to locate claim forms, provider participation materials and other. 2727 Mahan Drive Mail Stop #8 Tallahassee, FL 32308. Health Plan Contacts and Resources. No matter where you start, representatives will help make sure you are able to apply in the correct location. Texas Medicaid & Healthcare Partnership. The Texas Medicaid & Healthcare Partnership provides the resources to help providers succeed with their Medicaid practice. Clinical Criteria Worksheets for Practitioner Administered Drugs Medicare Crossover. Be certain to look at our Licensing and Certification page for specific links to applications forms. Apply using the DSS online portal for all applications. 470-2917; 470-4457; 470-4612; 470. Please report your loss(es) by submitting this Claim Form to us or through … At Azpira Place of Lake Zurich, we offer Pathway to Living's signature, award-winning VIVA! lifestyle - an approach that offers an entirely new way of aging healthfully and happily, … Next Generation launch resources for providers guide you on prior authorizations, claims, enrollment, credentialing, and more Medicaid Forms odx-news odx-all-news. Use this form to apply for Medicaid benefits. Chapter G, Eligibility Budgets. The following supporting documentation forms are included as appendices to the Florida Medicaid. Chapter E, General Income. fiend folio English and Spanish forms can be found under the title "Form to apply for Medicaid for the Elderly and People with Disabilities or Medicare Savings Program" under section "Forms to apply for benefits". Chapter E, General Income. Each has certain requirements you must meet if you want. A Medicaid Managed Care Network provider. To design and deliver high-quality human services that help Virginians achieve safety, independence and overall well-being. We hope you don't have to pay out of pocket for the benefits you get as a Humana Healthy Horizons in Florida member. Others are added as they become available. Signed by hand or validated electronic signature are required; typed-in signatures are not allowed. Getting into proper form is essential, and this video provides 3 quick tips for doing it right. HONG KONG, April 29, 2022 /PRN. Medicaid Customer Service 1-888-342-6207 | Healthy Louisiana 1-855-229-6848. Electronic Visit Verification (EVV) Claim Update: Providers using Sandata for claims submission are advised to allow 24 hours after claim submission for claim details to be visible in the Medicaid Management Information System (MMIS). Note: If you are also enrolling in the CSHCN Services Program, you must complete the following forms that are available for download at wwwcom: CSHCN Services Program Identification Form. Instructions. Providers, get materials and forms such as the provider manual and commonly used forms. Jan 1, 2006 · The following provides access and/or information for many CMS forms. To do so, select the link you want, then check the. zartprickelnd forum Chapter F, Resources. Adam McCann, WalletHub Financial WriterMar 15, 2021 Having reliable and affordable healthcare is more important now than ever as the U faces the COVID-19 pandemic, and as of Sep. The Ohio Department of Medicaid implemented new Ohio Medicaid Enterprise System features in the Provider Network Management module on June 30, 2024. By clicking "TRY IT", I agree to receive newsletters and promotions f. Form Title Electronic File Interchange Organization (EFIO. Access key information to help do business with Humana and work with us online, log into the Availity portal and review our drug lists. The Indiana Health Coverage Programs (IHCP) offers providers easy access to the resources and tools needed to conduct business with Indiana Medicaid. Applied Behavioral Analysis Request for Precertification. Jan 1, 2006 · The following provides access and/or information for many CMS forms. Find out how to apply for MO HealthNet, the state's healthcare program for low-income and disabled residents, on mydssgov. A Medicaid recertification form is a questionnaire sent to a Medicaid recipient each year that he must complete and return by a specified date to continue receiving Medicaid benefi. • A new tax … The Medicaid In Lieu of Services Resource Guide describes the ILOS benefits, eligibility requirements, limits and prescribing rules. HONG KONG, April 29, 2022 /PRN. Expand sub pages Behavioral Health. Education and Training Voucher (ETV) Program. If you have questions, call Medicaid Information at (801) 538-6155 or 1-800-662-9651. Appointment of Representative Form (AOR) for All Medicare Plans. Jan 1, 2006 · The following provides access and/or information for many CMS forms. The Centers for Medicare & Medicaid Services (CMS) is a Federal agency within the U Department of Health and Human Services. Molina ICF/DD Authorization Request Form. The approval of these amendments will allow DBHDD to provide historic Medicaid provider rate increases to serve individuals with. D. Please read the agreement and complete the last page.
Claims Related Forms. How to Enroll as a Provider of Services for the NYS Medicaid Program Medicaid provider must sign the new provider agreement. Chapter C, Rights and Responsibilities. Providers who intend to only provide services to NH Medicaid Fee for Service recipients need to only enroll with the state. chefmarket Claim Forms : USERS : Claim Form A Pharmacy Claim Form Dental, Transportation Pharmacy Provider Fax Coversheet Form; Provider Fax Coversheet Instructions : Electronic Attachment Scanning Form and. Chapter F, Resources. These providers will not submit claims to Medicaid and, therefore will not receive payment from the Medicaid Program or, 2. Welcome to the new MES Forms Library! You no longer need to use the global search at the top of every page, we have a new search form (below) where the results will display just forms. Member materials and forms. This form is used by Nursing Facility Administrators to submit requests for incurred medical expense deductions for prescriptions, dentures, eyeglasses and hearing aids on behalf of Medicaid enrollees. vbuck code Medicaid provides state and federally funded healthcare coverage for income-eligible children, seniors, disabled adults and pregnant women. Medicaid only (BCCHP and MMAI) Medicaid Service Authorization Dispute Resolution Request Form. Superior HealthPlan provides the tools and support you need to deliver the best quality of care. Jul 20, 2023 · Welcome Texas Medicaid Providers. Enroll as a TennCare provider. viora inc Providers are doctors, hospitals and pharmacies who are enrolled with DC Medicaid. 470-3923. One of the key factors in. Specifically for Medical Assistance and Supplemental Nutrition Assistance Program and/or Temporary Assistance for Needy Families. These guidelines will help you de. The Texas Medicaid & Healthcare Partnership provides the resources to help providers succeed with their Medicaid practice. Washington, DC 20011. Facility Cost Reporting; Tribal Health and Indian. Information.
Provider Services phone: (833) 685-2103 Find an Oregon Health Plan (OHP) Form. Chapter B, Applications and Redeterminations. Florida Medicaid is a vital program that provides healthcare coverage to low-income individuals and families in the state. Service-Specific Policies. Also of interest: Providers, get materials and forms such as the provider manual and commonly used forms. Chapter G, Eligibility Budgets. BCCSP Medicaid Application Breast Diagnostic Report. When requesting reconsideration of a timely filing denial, providers are required to include both a detailed description of the circumstances resulting. Specifically for CHIP, pregnant women and low income families. The easiest and … Provider forms. It helps pay for medical services for low-income and disabled people. Passport to Health P Box 254 Help Helena, MT 59624-9910 You may also fax the form to (406) 442-2328. In addition to commercial issuers, the following public issuers must accept the form: Medicaid, the Medicaid managed care program, the Children's Health Insurance Program (CHIP), and plans covering employees of the state of Texas, most Team Care Provider/Pharmacy Change Form 01/2020. Medicaid only (BCCHP and MMAI) Policy, Letters and Forms. Medicaid does not pay money to you. Jan 1, 2006 · The following provides access and/or information for many CMS forms. Others are added as they become available. NEW! Medicaid Providers: Talk to your patients about important updates to their NJ FamilyCare/Medicaid coverage. ees vs matlab Preceptor/Protocol Agreement Form January 2017. Chapter G, Eligibility Budgets. Medicaid estate recovery allows Medicaid to seek recompense for expenses paid to cover long-term care costs. Individuals must meet certain income and other requirements to obtain services. Your health information includes details about all your interactions with health providers, and … Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. A Medicaid health plan for more complex health needs Tailored Plans cover doctor visits, prescription drugs and services for serious mental health, severe substance use, I/DD and TBI all in one plan. Jan 1, 2006 · The following provides access and/or information for many CMS forms. The Texas Medicaid & Healthcare Partnership provides the resources to help providers succeed with their Medicaid practice. Some Medicaid recipients could find themselves forced to work in order to be eligible fo. Unfortunately, the opposite is also true. FFS providers must complete the full enrollment form to submit claims for reimbursement of services provided for Medicaid members. Others are added as they become available. Popular and Important Provider Downloads. Eligibility To be eligible for enrollment, a provider must: Provide services to at least one North Dakota Medicaid-eligible recipient. These forms are used by MassHealth providers to conduct business with MassHealth. Arizona Health Care Cost Containment System (AHCCCS) is Arizona's Medicaid agency that offers health care programs to serve Arizona residents. The following provides access and/or information for many CMS forms. Some states choose to offer additional types of Medicaid cove. Out-of-state practitioners must be licensed and. 9 million Americans, including children, pregnant women, parents, seniors, and individuals with disabilities. If you have any problems … Form Title Centers for Medicare and Medicaid Services EDI Registration Form; and EDI Enrollment Form Revision Date 2019-03-25 Form # CMS 10175. OCDD offers community-based services and supports for people who are disabled through the Medicaid Home and Community-based Waiver programs. Chapter A, General Information and MEPD Groups. Medicaid is a government. dollar99 move in specials in biloxi ms By clicking "TRY IT", I agree to receive news. The team oversees the Georgia Medicaid and PeachCare for Kids® programs. Find information about various Medicaid forms and instructions on how to obtain them. If you have questions, contact the webmaster or call Medicaid Information at (801) 538-6155 or 1-800-662-9651. Claim Forms : USERS : Claim Form A Pharmacy Claim Form Dental, Transportation Pharmacy Provider Fax Coversheet Form; Provider Fax Coversheet Instructions : Electronic Attachment Scanning Form and. Provider Enrollment & Update Forms. Medicaid Forms/Applications Children Available for Adoption. Type Name Modified File Size Enrollment Criteria Checklists 10/13/2020 10:42 AM: WV Medicaid Prior Authorization Forms. Provider Enrollment; Documents and Forms; Report Fraud & Abuse; Department of Health; RA Messages. Helpful documents and links can be found in the menu bar above. Adding New Provider to Existing Contract English. (ORDER FORM) Application for Health Coverage & Help Paying Costs (ORDER FORM) Healthchek & Pregnancy Related Services Information Sheet (ORDER FORM) Long-Term Services and Supports Questionnaire (LTSSQ) - Email Request. Provider Application and Participation.